THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rodwelch@pacbell.net
S U M M A R Y
DIARY: December 10, 2008 12:34 PM Wednesday;
Rod Welch
Millie blood test at Kaiser for ANC evaluate Neupogen treatments.
1...Summary/Objective
2...Laboratory Blood Test Results Posted Kaiser's Computer
3...Cancer Marker CA 15-3 197 Rise from 105 After 3 Months Stable
..............
Click here to comment!
CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 14 0000. ref SDS 11 0000.
040502 -
040503 -
040504 -
040505 -
040507 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Background on blood tests and follow up leading to Neupogen treatments
040902 - on 081205 and 081206 is reported in the record on 081203. ref SDS 14
040903 - 7N5I
040905 - ..
040906 - On 081206 Millie submitted complete lab to UCSF, ref SDS 20 2K4U,
040907 - showing ANC 624 and asking about doing a follow up blood test this
040908 - week to consider additional Neupogen treatments on 081212 and 081213.
040909 - ref SDS 20 2K5U
040911 - ..
040912 - This morning called and talked to Glenna. ref SDS 22 6S9M She said
040913 - that Doctor Rugo approved Millie for Neupogen based on Kaiser's
040914 - determination of blood counts. ref SDS 22 6S56 Glenna called Arlette
040915 - to discuss doing a blood test to evaluate whether Nuepogen treatments
040916 - last week on 081205 and 081206 increased Millie's ANC enough, or
040917 - whether she she needs a 3rd treatment this week and/or treatments
040918 - already scheduled for 081212 and 081213, as set out in the letter to
040919 - the medical team on 081209. ref SDS 21 RL6Q Something went wrong in
040920 - the communication between Glenna and Arlette. Glenna reported that
040921 - Arlette referred Glenna to the Kaiser Pharmacy for scheduling a blood
040922 - test. ref SDS 22 6S9M Glenna asked Millie to coordinate with Kaiser
040923 - on ordering the blood test. ref SDS 22 6131
040924 -
040925 - [On 081210 primary care physician called Millie and advised
040926 - that ANC 1085 in blood test on 081210 does not require
040927 - Neupogen under Kaiser standards and practices until ANC
040928 - falls below 1000, ref SDS 24 J43V; doctor ordered follow up
040929 - blood test on 081212 to evaluate ANC below 1000 based on
040930 - patient history indicating ANC falling 120+ points per day
040931 - on sunitinib treatment protocol, which would cause ANC to
040932 - drop below 500 without Neupogen until Millie's next
040933 - scheduled lab at UCSF on 081218. ref SDS 24 H44M
040935 - ..
040936 - Called Arlette. She checked Kaiser's computer and determined that
040937 - Millie should have a follow up blood test. Arlette ordered the test.
040938 - ref SDS 23 616R
040940 - ..
040941 - Millie was at a cancer support group meeting that ended at 1230.
040943 - ..
040944 - Called and explained progress setting up blood test today. ref SDS 23
040945 - W98J
040947 - ..
040948 - On the way home, Millie stopped at Kaiser and got the blood test.
040949 -
040950 -
040951 -
040953 - ..
0410 -
0411 -
0412 - 1512
0413 -
041301 - Laboratory Blood Test Results Posted Kaiser's Computer
041302 -
041303 - Follow up ref SDS 16 M85G, ref SDS 9 FW5N.
041304 -
041305 - Kaiser posted partial results of blood test today. ref SDS 0 S65I ANC
041306 - 1085 (NEUTS 1.085) improved from 624 from the test on 081203,
041307 - ref SDS 16 QY6H; still 400 plus points below target range of 1500.
041308 - ref SDS 0 QY6H
041310 - ..
041311 - Previous lab at Kaiser a week ago on 081203, and reported in the
041312 - record on 081205, ref SDS 16 075H, prior lab at UCSF was on 081126.
041313 - ref SDS 9 075H
041314 -
041316 - ..
041317 - Patient Provider Category View FR Date To Date
041331 - ..
041332 - 72/F Lab Results Summary
041334 - ..
041335 - Log#: 510834502257 081210 13:01 (Results 1337)
041336 - <------------------- KAISER -----------------------><----------------- UCSF --------------------->
041337 - Type Results Units Normal Type Units Normal ACRO
041338 - ..
041339 - CBC with DIFF & PLT CT CBCD
041340 - ..
041341 - WBC L 3.1 K/uL 3.4 - 10.0 WBC x10-3 x10E9/L 3.4 - 10 WBC
041342 - RBC L 3.22 M/uL 3.60 - 5.70 RBC x10-6 x10E12/L 4 - 5.2 RBC
041343 - Hemoglobin L 10.6 g/dL 11.5 - 15.0 Hemoglobin g/dL 12 - 15.5 HGB
041344 - Hematocrit L 31.6 % 34.0 - 46.0 Hematocrit PERCENT 36 - 46 HCT
041345 - MCV 98 fL 80.0 - 100.0 MCV fL 80 - 100 MCV
041346 - RDW, RBC H 15.5 % 11.9 - 14.3 [Not Reported at UCSF]
041347 - MCH [Not Reported] MCH pg 26 - 34 MCH
041348 - MCHC [Not Reported] MCHC g/dL 31 - 36 MCHC
041349 - ..
041350 - Platelets L 67 K/uL 140 - 400 Plt x10-3 x10E9/L 140 - 450 PLT
041352 - ..
041353 - On 081203 UCSF advised that blood test on 081203 showing platelets 109
041354 - is not worrisome. ref SDS 19 GF8Q
041355 -
041356 - [On 081211 Millie letter to medical team asks about effects
041357 - on health care with platelets falling below 60% of the
041358 - target range. ref SDS 25 S28P
041360 - ..
041361 - [On 081219 1140 primary care physician concurs UCSF order
041362 - to pause treatments, ref SDS 27 JK7H, due to rising
041363 - cytopenia, including pancytopenia from expanded low blood
041364 - counts that risks fatal infection. ref SDS 27 LS6K
041366 - ..
041367 - CBC blood test continues...
041368 -
041369 - Log#: 510834502257 081210 13:01 (Results 1337)
041370 - <------------------- KAISER -----------------------><----------------- UCSF --------------------->
041371 - Type Results Units Normal Type Units Normal ACRO
041372 - (posted 081212, ref SDS 26 6Z4F)
041373 - CA 15-3 H* 197 U/mL < 39 CA 15-3 U/mL < 33 CA153
041374 -
041375 - ..
041376 - (calculated with formula on 081205. ref SDS 18 JG6F)
041377 - ANC L 1085 -> 1500 NEUTS x10E9/L 1.8 - 6.8 N-A
041378 - Neutrophils L 35 % 41 - 81 Neutrophils
041379 -
041380 - ANC = WBC x 1000 x (Neutrophils + Bands)
041381 -
041382 - 3.1 x 1000 x (.35 + 0) = 1085
041384 - ..
041385 - [On 081210 primary care physician called Millie and advised
041386 - that ANC 1085 in blood test on 081210 does not require
041387 - Neupogen under Kaiser standards and practices until ANC
041388 - falls below 1000, ref SDS 24 J43V; doctor ordered follow up
041389 - blood test on 081212 to evaluate ANC below 1000 based on
041390 - patient history indicating ANC falling 120+ points per day
041391 - on sunitinib treatment protocol, which would cause ANC to
041392 - drop below 500 without Neupogen until Millie's next
041393 - scheduled lab at UCSF on 081218. ref SDS 24 H44M
041395 - ..
041396 - Log#: 510834502257 081210 13:01 (Results 1337)
041397 - <------------------- KAISER -----------------------><----------------- UCSF --------------------->
041398 - Type Results Units Normal Type Units Normal ACRO
041399 - Lymphocytes H 53 % 13 - 46 LYMPHS x10E9/L 0.9 - 2.9 L-A
041400 - Monocyte 4 % 4 - 12 MONOS x10E9/L 0.2 - 0.8 M-A
041401 - Esoinophils H 8 % 0 - 4 EOS x10E9/L 0.0 - 0.4 E-A
041402 - Basophil 1 % 0 - 1 BASOS x10E9/L 0.0 - 0.1 B-A
041403 -
041405 - ..
041406 - Log#: 510834502257 081210 13:01 (Results 1337)
041407 - <------------------- KAISER -----------------------><----------------- UCSF --------------------->
041408 - Type Results Units Normal Type Units Normal ACRO
041409 - Total Protein [No Report] g/dL 6.0 - 7,7 PROTEIN, TOTAL g/dL 5.8 - 8.0 TP
041410 - ALBUMIN 4.4 g/dL 3.3 - 4.7 ALBUMIN g/dL 3.4 - 4.7 ALB
041411 - Calcium 9.0 mg/dL 8.5 - 10.3 CALCIUM mg/dL 8.7 - 10.1 CA
041412 - ..
041413 - Magnesium 1.9 mg/dL 1.7 - 2.3 MAGNESIUM mg/dL 1.8 - 2.3 MG
041414 - Glucose Random 100 mg/dL 60 - 159 GLUCOSE mg/dL 70 - 199 GLU
041415 - ALT (SGPT) 20 U/L -< 36 ALT U/L 11 - 54 ALT
041417 - ..
041418 - Log#: 510834502257 081210 13:01 (Results 1337)
041419 - <------------------- KAISER -----------------------><----------------- UCSF --------------------->
041420 - Type Results Units Normal Type Units Normal ACRO
041421 - Creat with GFR
041422 - Creatinine 0.66 mg/dL -< 1.11 CREATININE mg/dL 0.42 - 1.06 CR
041423 -
041424 - Note: Creatinine assay changed to IDMS standardization on
041425 - February 4, 2008 causing decrease in results of approximately
041426 - 0.09 mg/dL
041428 - ..
041429 - GFR Non-Afr Am >60 mL/min > 60 - eGFR if Caucasian >60 mL/min GFRC
041430 - GFR African AM >60 mL/min > 60 eGFR if African Amer >60 mL/min GFRA
041431 - GFR Note **
041432 -
041433 -
0415 -
SUBJECTS
Default Null Subject Account for Blank Record
0503 -
050401 - ..
050402 - Cancer Marker CA 15-3 197 Rise from 105 After 3 Months Stable
050403 -
050404 - Follow up ref SDS 9 VK6H. ref SDS 4 VK6H.
050405 -
050406 - The last test was on 081126. ref SDS 9 VK6H
050408 - ..
050409 - Significant rise of cancer marker from CA 15-3 105 on 081126 to CA
050410 - 15-3 197 today, ref SDS 0 A16M, may reflect CT test of the neck on
050411 - 081107, which found increasing adenopathy, particularly on the right
050412 - supraclavicular side, reviewed on 081113. ref SDS 6 HW8M
050413 -
050414 -
050415 -
050416 -
050417 -
050418 -
050419 -
050420 -
0505 -